376.1210. 1. Each entity offering individual and group health insurancepolicies providing coverage on an expense-incurred basis, individual and groupservice or indemnity type contracts issued by a nonprofit corporation,individual and group service contracts issued by a health maintenanceorganization, all self-insured group arrangements to the extent not preemptedby federal law, and all managed health care delivery entities of any type ordescription, that are delivered, issued for delivery, continued or renewed inthis state on or after January 1, 1997, and providing for maternity benefits,shall provide coverage for a minimum of forty-eight hours of inpatient carefollowing a vaginal delivery and a minimum of ninety-six hours of inpatientcare following a cesarean section for a mother and her newly born child in ahospital as defined in section 197.020, RSMo, or any other health carefacility licensed to provide obstetrical care under the provisions of chapter197, RSMo.
2. Notwithstanding the provisions of subsection 1 of this section, anyentity offering individual and group health insurance policies providingcoverage on an expense-incurred basis, individual and group service orindemnity type contracts issued by a nonprofit corporation, individual andgroup service contracts issued by a health maintenance organization, allself-insured group arrangements to the extent not preempted by federal law,and all managed health care delivery entities of any type or description thatare delivered, issued for delivery, continued or renewed in this state on orafter January 1, 1997, and providing for maternity benefits, may authorize ashorter length of hospital stay for services related to maternity and newborncare if:
(1) A shorter hospital stay meets with the approval of the attendingphysician after consulting with the mother. The physician's approval todischarge shall be made in accordance with the most current version of the"Guidelines for Perinatal Care" prepared by the American Academy of Pediatricsand the American College of Obstetricians and Gynecologists, or similarguidelines prepared by another nationally recognized medical organization; and
(2) The entity providing the individual or group health insurance policyprovides coverage for post-discharge care to the mother and her newborn.
3. Post-discharge care shall consist of a minimum of two visits at leastone of which shall be in the home, in accordance with accepted maternal andneonatal physical assessments, by a registered professional nurse withexperience in maternal and child health nursing or a physician. The locationand schedule of the post-discharge visits shall be determined by the attendingphysician. Services provided by the registered professional nurse orphysician shall include, but not be limited to, physical assessment of thenewborn and mother, parent education, assistance and training in breast orbottle feeding, education and services for complete childhood immunizations,the performance of any necessary and appropriate clinical tests and submissionof a metabolic specimen satisfactory to the state laboratory. Such servicesshall be in accordance with the medical criteria outlined in the most currentversion of the "Guidelines for Perinatal Care" prepared by the AmericanAcademy of Pediatrics and the American College of Obstetricians andGynecologists, or similar guidelines prepared by another nationally recognizedmedical organization. Any abnormality, in the condition of the mother or thechild, observed by the nurse shall be reported to the attending physician asmedically appropriate.
4. For the purposes of this section, "attending physician" shall includethe attending obstetrician, pediatrician, or other physician attending themother or newly born child.
5. Each entity offering individual and group health insurance policiesproviding coverage on an expense-incurred basis, individual and group serviceor indemnity type contracts issued by a nonprofit corporation, individual andgroup service contracts issued by a health maintenance organization, allself-insured group arrangements to the extent not preempted by federal law andall managed health care delivery entities of any type or description shallprovide notice to policyholders, insured persons and participants regardingthe coverage required by this section. Such notice shall be in writing andprominently positioned in the policy, certificate of coverage or summary plandescription.
6. Such health care service shall not be subject to any greaterdeductible or co-payment than other similar health care services provided bythe policy, contract or plan.
7. No insurer may provide financial disincentives to, or deselect,terminate the services of, require additional documentation from, requireadditional utilization review, or reduce payments to, or otherwise penalizethe attending physician in retaliation solely for ordering care consistentwith the provisions of this section.
8. The department of insurance, financial institutions and professionalregistration shall adopt rules and regulations to implement and enforce theprovisions of this section. No rule or portion of a rule promulgated pursuantto this section shall become effective unless it has been promulgated pursuantto the provisions of section 536.024, RSMo.
376.1210. 1. Each entity offering individual and group health insurancepolicies providing coverage on an expense-incurred basis, individual and groupservice or indemnity type contracts issued by a nonprofit corporation,individual and group service contracts issued by a health maintenanceorganization, all self-insured group arrangements to the extent not preemptedby federal law, and all managed health care delivery entities of any type ordescription, that are delivered, issued for delivery, continued or renewed inthis state on or after January 1, 1997, and providing for maternity benefits,shall provide coverage for a minimum of forty-eight hours of inpatient carefollowing a vaginal delivery and a minimum of ninety-six hours of inpatientcare following a cesarean section for a mother and her newly born child in ahospital as defined in section 197.020, RSMo, or any other health carefacility licensed to provide obstetrical care under the provisions of chapter197, RSMo.
2. Notwithstanding the provisions of subsection 1 of this section, anyentity offering individual and group health insurance policies providingcoverage on an expense-incurred basis, individual and group service orindemnity type contracts issued by a nonprofit corporation, individual andgroup service contracts issued by a health maintenance organization, allself-insured group arrangements to the extent not preempted by federal law,and all managed health care delivery entities of any type or description thatare delivered, issued for delivery, continued or renewed in this state on orafter January 1, 1997, and providing for maternity benefits, may authorize ashorter length of hospital stay for services related to maternity and newborncare if:
(1) A shorter hospital stay meets with the approval of the attendingphysician after consulting with the mother. The physician's approval todischarge shall be made in accordance with the most current version of the"Guidelines for Perinatal Care" prepared by the American Academy of Pediatricsand the American College of Obstetricians and Gynecologists, or similarguidelines prepared by another nationally recognized medical organization; and
(2) The entity providing the individual or group health insurance policyprovides coverage for post-discharge care to the mother and her newborn.
3. Post-discharge care shall consist of a minimum of two visits at leastone of which shall be in the home, in accordance with accepted maternal andneonatal physical assessments, by a registered professional nurse withexperience in maternal and child health nursing or a physician. The locationand schedule of the post-discharge visits shall be determined by the attendingphysician. Services provided by the registered professional nurse orphysician shall include, but not be limited to, physical assessment of thenewborn and mother, parent education, assistance and training in breast orbottle feeding, education and services for complete childhood immunizations,the performance of any necessary and appropriate clinical tests and submissionof a metabolic specimen satisfactory to the state laboratory. Such servicesshall be in accordance with the medical criteria outlined in the most currentversion of the "Guidelines for Perinatal Care" prepared by the AmericanAcademy of Pediatrics and the American College of Obstetricians andGynecologists, or similar guidelines prepared by another nationally recognizedmedical organization. Any abnormality, in the condition of the mother or thechild, observed by the nurse shall be reported to the attending physician asmedically appropriate.
4. For the purposes of this section, "attending physician" shall includethe attending obstetrician, pediatrician, or other physician attending themother or newly born child.
5. Each entity offering individual and group health insurance policiesproviding coverage on an expense-incurred basis, individual and group serviceor indemnity type contracts issued by a nonprofit corporation, individual andgroup service contracts issued by a health maintenance organization, allself-insured group arrangements to the extent not preempted by federal law andall managed health care delivery entities of any type or description shallprovide notice to policyholders, insured persons and participants regardingthe coverage required by this section. Such notice shall be in writing andprominently positioned in the policy, certificate of coverage or summary plandescription.
6. Such health care service shall not be subject to any greaterdeductible or co-payment than other similar health care services provided bythe policy, contract or plan.
7. No insurer may provide financial disincentives to, or deselect,terminate the services of, require additional documentation from, requireadditional utilization review, or reduce payments to, or otherwise penalizethe attending physician in retaliation solely for ordering care consistentwith the provisions of this section.
8. The department of insurance, financial institutions and professionalregistration shall adopt rules and regulations to implement and enforce theprovisions of this section. No rule or portion of a rule promulgated pursuantto this section shall become effective unless it has been promulgated pursuantto the provisions of section 536.024, RSMo.
376.1210. 1. Each entity offering individual and group health insurancepolicies providing coverage on an expense-incurred basis, individual and groupservice or indemnity type contracts issued by a nonprofit corporation,individual and group service contracts issued by a health maintenanceorganization, all self-insured group arrangements to the extent not preemptedby federal law, and all managed health care delivery entities of any type ordescription, that are delivered, issued for delivery, continued or renewed inthis state on or after January 1, 1997, and providing for maternity benefits,shall provide coverage for a minimum of forty-eight hours of inpatient carefollowing a vaginal delivery and a minimum of ninety-six hours of inpatientcare following a cesarean section for a mother and her newly born child in ahospital as defined in section 197.020, RSMo, or any other health carefacility licensed to provide obstetrical care under the provisions of chapter197, RSMo.
2. Notwithstanding the provisions of subsection 1 of this section, anyentity offering individual and group health insurance policies providingcoverage on an expense-incurred basis, individual and group service orindemnity type contracts issued by a nonprofit corporation, individual andgroup service contracts issued by a health maintenance organization, allself-insured group arrangements to the extent not preempted by federal law,and all managed health care delivery entities of any type or description thatare delivered, issued for delivery, continued or renewed in this state on orafter January 1, 1997, and providing for maternity benefits, may authorize ashorter length of hospital stay for services related to maternity and newborncare if:
(1) A shorter hospital stay meets with the approval of the attendingphysician after consulting with the mother. The physician's approval todischarge shall be made in accordance with the most current version of the"Guidelines for Perinatal Care" prepared by the American Academy of Pediatricsand the American College of Obstetricians and Gynecologists, or similarguidelines prepared by another nationally recognized medical organization; and
(2) The entity providing the individual or group health insurance policyprovides coverage for post-discharge care to the mother and her newborn.
3. Post-discharge care shall consist of a minimum of two visits at leastone of which shall be in the home, in accordance with accepted maternal andneonatal physical assessments, by a registered professional nurse withexperience in maternal and child health nursing or a physician. The locationand schedule of the post-discharge visits shall be determined by the attendingphysician. Services provided by the registered professional nurse orphysician shall include, but not be limited to, physical assessment of thenewborn and mother, parent education, assistance and training in breast orbottle feeding, education and services for complete childhood immunizations,the performance of any necessary and appropriate clinical tests and submissionof a metabolic specimen satisfactory to the state laboratory. Such servicesshall be in accordance with the medical criteria outlined in the most currentversion of the "Guidelines for Perinatal Care" prepared by the AmericanAcademy of Pediatrics and the American College of Obstetricians andGynecologists, or similar guidelines prepared by another nationally recognizedmedical organization. Any abnormality, in the condition of the mother or thechild, observed by the nurse shall be reported to the attending physician asmedically appropriate.
4. For the purposes of this section, "attending physician" shall includethe attending obstetrician, pediatrician, or other physician attending themother or newly born child.
5. Each entity offering individual and group health insurance policiesproviding coverage on an expense-incurred basis, individual and group serviceor indemnity type contracts issued by a nonprofit corporation, individual andgroup service contracts issued by a health maintenance organization, allself-insured group arrangements to the extent not preempted by federal law andall managed health care delivery entities of any type or description shallprovide notice to policyholders, insured persons and participants regardingthe coverage required by this section. Such notice shall be in writing andprominently positioned in the policy, certificate of coverage or summary plandescription.
6. Such health care service shall not be subject to any greaterdeductible or co-payment than other similar health care services provided bythe policy, contract or plan.
7. No insurer may provide financial disincentives to, or deselect,terminate the services of, require additional documentation from, requireadditional utilization review, or reduce payments to, or otherwise penalizethe attending physician in retaliation solely for ordering care consistentwith the provisions of this section.
8. The department of insurance, financial institutions and professionalregistration shall adopt rules and regulations to implement and enforce theprovisions of this section. No rule or portion of a rule promulgated pursuantto this section shall become effective unless it has been promulgated pursuantto the provisions of section 536.024, RSMo.
